You’ve recently noticed that spot in the mirror.
And felt that breakout coming.
But did you know that blemish has been brewing for a while?
That’s why the first step toward clearer skin is to understand not all acne is the same.
You can’t treat your pimples like you’d approach an inflamed pustule.
There are four stages a pimple has to go through before it becomes fully-fledged acne.
To help you demystify your breakouts and put your acne classifications into perspective, we’ve called on our clinical skin expert, Samantha.
4 Stages of Acne
First, a quick recap: why does acne occur?
Your skin contains countless pores (news flash) — but do you know what that means?
Pores are tiny openings on your skin’s surface that contain a hair follicle and a sebaceous oil gland.
When your skin is healthy, these pores release sebum that moisturises the skin; if debris from bacteria, white blood cells, and dead skin cells become trapped inside the pore, this leads to inflammation, causing swelling which ruptures the pore wall, allowing bacteria to spread into the surrounding area, leading to breakouts — it’s a vicious cycle.
While oil on your skin at healthy levels keeps your skin supple, an overproduction increases your chance of developing acne.
Scientific evidence has found that the average rate of sebum production is much higher in those with acne than in those without (1)
Acne can start off mild, but it can quickly progress into more severe forms such as cystic acne; these are inflamed lesions that have a greater chance of scarring and causing post-inflammatory hyperpigmentation (PIH), which is why it’s important to get your breakouts under control as soon as you are aware of them.
We cover this in our article 10 skincare hacks to prevent acne, where we look at the factors that can cause your breakouts, such as hormones, genetics, lifestyle, and environment.
It’s important to understand the four different acne stages discussed below.
But first, let’s look at how a pimple is formed on your skin.
The Different Types of Breakouts
When pores become infected, your breakout changes; thankfully, not every pimple makes it to the second, third or fourth stage.
When it does, there are several forms your pimples may take, which we have outlined below, from mild to severe.
It’s also important to know that acne can be broken down into two classifications: inflammatory and non-inflammatory.
When a pimple starts, microscopic amounts of dirt and debris get trapped in the pore, casing micro-comedones — undetectable to the naked eye — which are baby blemishes.
This buildup of sebum and dead cells forms a plug that blocks the pore preventing it from opening and leading to even more buildup. At this point, your blemish becomes a full-fledged comedone.
Blackheads: These are non-inflammatory comedones or open plugged pores. Once open to the air oxidises the oil causing the characteristic dark colour.
Whiteheads: These are non-inflammatory comedones or closed plugged pores. They occur when oil and your skin cells prevent the clogged pore from opening and are light in colour.
Papules: These are best described as inflamed lesions on the surface of your skin. They are often small and red and are not always visible to the naked eye.
Pustules: Aka pimples are papules with pus that purge when squeezed. The debris in the pore builds up at the hair follicle’s root, creating pus, which causes inflammation and redness. Papules are raised and dome-shaped, making them more noticeable.
If you can get your acne under control at this stage and treated early enough, none of these will turn into painful nodules or cysts, and you can eliminate any chance of scarring or PIH.
Nodules: Large, complex lesions that can be very painful; they can’t be squeezed as they don’t contain pus.
Cysts: Deep, painful, pus-filled lesions have the highest chance of causing scars.
Acne Vulgaris: Acne vulgaris classification is associated with irregular-shaped lesions that reside deep in the dermis; cysts are usually apparent with acne vulgaris.
Often, there is a temptation to squeeze these cysts, but you need to resist this, as it can cause deeper infection and scarring.
The Four Stages of Acne Classifications
Your dermatologists will visually assess your skin to determine the type and severity of your acne. In general, acne falls into one of these four stages:
Grade 1: Non-inflammatory acne; this consists of micro-comedones, comedones, and the occasional papule and pustule.
Grade 2: This is still non-inflammatory acne; comedones, papules, and a few pustules may be present on your skin, and it is mainly confined to your face.
Grade 3: At this level, inflammatory acne occurs. This acne severity classification is usually associated with papules, pustules, nodules, and the occasional cyst progress to a more severe form that may also be present on your back; grade 3 is usually associated with sensitivity and inflammation.
Grade 4: This is a chronic form of inflammatory acne and, aside from your face, may be present on your arms, back, chest, neck, and upper thighs. It can do untold damage in the form of acne scars and dark spots (PIH) if you don’t get this condition under control early enough.
With these acne classifications grade, a lot is going on in your skin:
- post-inflammatory pigmentation
- large dome-shaped lesions
- painful pus-filled cysts that have difficulty healing
- blackheads and whiteheads on your T. Zone
- acne scars classifications and treatment is challenging to assess and treat.
Acne fulminans: This is a rare form of acne which comes on abruptly in the form of acute inflammation that can lead to ulceration, aching of the joints, and even fever. (2)
Gram-Negative Folliculitis: This is an inflammatory acne disorder caused by a bacterial infection due to complications from Acne Vulgaris or Rosacea. It can be treated by ineffective antibiotic treatment, and timely intervention by a dermatologist is critical when treating this type of acne,
Acne grades are diagnosed on the presence or absence of inflammation, observing the number and type of dominant lesions and how widespread the acne is.
The treatment plan must consider many factors – including the causes of acne and your age,
The Best Treatment Options
Most acne medications and treatments often target only one or two of the critical factors that cause acne, which either decreases or blocks sebum production.
Mild to moderate grades 1 and 2
There are proven natural treatments that can help to keep your breakouts under control, which we discuss in our article on how to get rid of acne with essential oils.
Some over-the-counter medications and creams are enough to treat and clear your skin at this grade.
There are common side effects of topical medications ranging from mild irritation to dry skin, so you must watch your skin and become your label detective.
For moderate to severe grades 3 and 4
Systemic medications can be much more helpful.
Retinoids are Vitamin A derivatives that your doctor or dermatologist may prescribe; they regulate the process of healthy cell turnover, unclog pores, destroy bacteria, and reduce inflammation in your skin.
This is backed up by research showing that retinoids can help decrease the number of comedones and inflammatory lesions by as much as 50% to 70%. (3)
Antibiotics such as doxycycline and minocycline help to kill off bacteria; the downside is that they can make you more resistant to other strains of healthy bacteria.
If you are experiencing hormonal acne, you may be prescribed birth control pills with other medications, such as retinoids, to get your breakouts under control.
How to Heal Your Acne
Don’t squeeze, pop or pick your pimples: you could push the infection down deeper, making matters worse and causing permanent scarring.
We advise our clients to keep their blemishes covered with a spot treatment as a deterrent, like Resq anti-blemish skin shot with salicylic acid to protect and heal pimples and ease inflammation.
Even if you leave your pimple alone, there’s still a good chance you’ll experience post-inflammatory hyperpigmentation (PIH), those brown spots that can linger for what feels like forever after a breakout.
Glo dark spot corrector is a highly-concentrated formula that will pull your hyperpigmentation from the dermis to eradicate it,
To Conclude, the naked truth.
Effectively controlling your acne means managing it at every stage — and preventing breakouts from the outset is essential.
Understanding the different acne classifications is useful; once you know the right grade, you can treat your skin more effectively.
If you are experiencing Grade 1,2 acne, it is possible to treat it with natural ingredients and over-the-counter topical medications.
For those with a more severe form of acne at Grade 4 or 5 levels, your doctor or dermatologist will diagnose your condition and prescribe a course of retinoids or antibiotics to help clear your skin.
You should talk to your doctor about the possible side effects of this treatment and discuss any concerns you may have.